| NPI | 1245664838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN653658) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 162278) |
| Enumeration Date | 2013-08-30 |
| Last Update Date | 2018-05-02 |